Advice on test results

[Lita22]

Hi I'm new here and after a bit of advice please. I was diagnosed with hypothyroidism about 20 years ago (I was 22at the time) and have been on 75 mcg levothyroxine for most of that time.Since diagnosis I have continued to suffer with fatigue, depression, brain fog, and in the past 10 years neurological symptoms such as pins and needles, numbness in my hands, legs and face, and restless legs

I was diagnosed with b12 deficiency (although negative intrinsic factor test)last June and have been self injecting B12 every other day since and have been taking cofactors. My symptoms greatly improved but started to return after Christmas. A doctor in Cambridge advised this could be due to a drop in my ferritin levels so I had an iron infusion 6 weeks ago.

The neurological symptoms remain and I am continuing to feel fatigued, light headed, irritable, have brain fog and often feel cold.

I had a tsh test a month ago and was advised it was below range at 0.2 so needs to be repeated as they think I'm over-medicated (I'm aware they can't base this on tsh alone).

My GP has agreed to further blood tests at the end of August on the advice from the doctor in Cambridge. These will include various antibodies, iron, vit d, folate, and the repeat thyroid tests.

I previously had low vitamin d and folate, but both have improved significantly over the last year with supplements.

I have had macrocytosis for over 20 years as well and this has not corrected despite the b12 injections.

I had a medichecks test this week:

Tsh 1.34 (0.27-4.2)

T3 4.1 (3.1-6.8)

T4. 15.4 (12-22)

I'm not sure whether my thyroid could be causing any of these symptoms? I'm just trying to rule things out at the moment.

Apologies for the long post. Any advice would be welcomed. Many thanks

[SlowDragon Administrator]

welcome to the forum

Was test done early morning and last dose levothyroxine 24 hours before test

FT4: 15.4 pmol/l (Range 12 - 22)

Ft4 only 34.00% through range

FT3: 4.1 pmol/l (Range 3.1 - 6.8)

Ft3 only 27.03% through range

These results suggest you need dose increase in levothyroxine

Most people when adequately treated will have Ft4 and Ft3 at least 60% through range

75mcg is only one step up from starter dose

Approx how much do you weigh in kilo

Do you know if your hypothyroidism is autoimmune, usually diagnosed by high thyroid antibodies

[Lita22 in reply to SlowDragon]

Thank you for your response.I did ensure the test was early morning and hadn't taken levothyroxine for 24hrs.

I weigh 53kg.

I've never had an antibody test, but my GP is going to do one in August.

[SlowDragon Administrator in reply to Lita22]

so…..you might need SMALL dose increase initially

53kg x 1.6mcg = 84.8mcg per day as suggested guideline dose

84.8mcg x 7 days = 593mcg per week

75mcg 4 days week and 100mcg 3 days week = 600mcg per week

75mcg 5 days week and 100mcg 3 days week = 575mcg

Currently you’re taking 525mcg per week

If you have high thyroid antibodies (hashimoto’s) it’s always worth trying strictly gluten free diet and/or dairy free diet …..this can improve absorption of levothyroxine

Do you take levothyroxine on empty stomach and then nothing apart from water for at least an hour after and not vitamin supplements for at least 2 hours after

Iron, magnesium and vitamin D tablets….at least 4 hours away from levothyroxine

Taking levothyroxine at bedtime can give better results

Or you might need slightly higher dose levothyroxine than guidelines

[SlowDragon Administrator]

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Lita22 in reply to SlowDragon]

That's really useful, thanks so much.I do take levothyroxine first thing on an empty stomach but I probably taking vitamin d within 2 hrs. I'll try switching to taking it before bed.

I'm also going to cut out dairy and gluten and see how that goes

I think my tsh is always on the low side. Doctors have dropped me down to 50mcg a few times and I've felt horrendous so they end up letting me go back to 75. They very rarely test T4 and T3, just rely on tsh.